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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2010 April;23(2):55-8
Abdominal compartment syndrome in acute pancreatitis
Basile G., Evola G., Corsaro A., Buffone A.
Dipartimento di Chirurgia , Sezione di Chirurgia d’Urgenza e Generale, Università degli Studi di Catania, Catania
The observation of 4 cases of abdominal compartment syndrome (A.C.S.) in patients with acute necrotic pancreatitis, one of whom unfortunately died, has lead the Authors to clear the physiopathology and the therapy, on the basis of the most recent literature. A.C.S. occurs in patients with necrotic pancreatitis essentially because of the collection of fluids in the peritoneal cavity, secondary to the increase of the capillary permeability, which takes place in the presence ofA an enflamed organ. Once it starts, A.C.S. is responsible of a series of damages on organs and systems (kidneys, liver, bowel, heart, vessels, lungs) which may cause rapidly a multiple organ failure, with high incidence of mortality. To avoid this it’s mandatory to start as soon as possible a medical or surgical treatment. The first, which is usually successful in patients with an intra-abdominal pressure (i.a.p.) below 25 mm Hg, consists of administration of fluids, gabesate or octreotide, insulin, inotrops, diuretics, heparin, antibiotics, together with, if necessary, mechanical ventilation. When, on the contrary, i.a.p. is over 25 mm Hg or general conditions become poor nevertheless low pressure values, it’s imperative to switch to surgical treatment with a laparotomy and decompression (suction of intraperitoneal fluids), followed by specific treatment for pancreatitis and finally by closure of abdominal wall, straight, temporary (prosthesis, plastic bag) or through a laparostomy. The best cure of A.C.S. however remains its prevention or its rapid identification, which may be reached by a close monitoring of all patients admitted for acute necrotic pancreatitis, accomplished through frequent clinical exams, including measurement of i.a.p., and laboratory tests, so that the most appropriate treatment may be promptly applied.